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Abdominoscrotal Hydrocoele
Ali Reza Shojai*, Kundan K Patil**, Raj Gautam**, GS Narshetty***,
Tushar Jadhav****, Mahesh Pukar**
 

While hydrocoele is among the commonest inguinal anomalies in children, less than 20 cases have been reported of its extreme form, i.e. the abdomino-scrotal hydrocoele (ASH).1 We report a rare case of a young adult with Abdomino-scrotal hydrocoele even though it is common in children.

Introduction
Hydrocoele is the abnormal accumulation of the fluid in the patient ‘processus vaginalis, an exudation cyst’.

It is one of the common scrotal swellings in adults and common inguinal anomalies in children.

But as an extreme form, extending from scrotal to intraabdominal cavity, it is the rare case, usually the presenting age is of childhood.

We had one adult patient (35 yrs) presenting abdomino scrotal swelling which was found to be ‘Hydrocoele’.

Case Report
A 26 year old male presented with a swelling in the left side of scrotum since 4 year, progressively increasing in size. At the time of presentation he had massive swelling of 20 cm x 15 cm, extending from the base of scrotum to the inguinal canal and hypogastrium. It was irreducible with no impulse on coughing. We could not get above the swelling. It was transilluminant, cross fluctuation was elicited. Left testis was separately palpable (Fig. 1).

CT scan showed a cystic swelling of 35 cm x 15 cm x 10 cm in size extending from the scrotum into the inguinal canal and pelvis up to the L4 vertebra anterior to pectineus muscle, causing compression of posterolateral wall of the urinary bladder. Terminal left ureter was stretched and displaced by the mass.

Exploration with inguinoscrotal incision was done. Sac was dissected upto the deep ring. The deep ring was stretched and the sac was extending into the pelvic cavity. After division of internal ring, the sac was dissected out. During dissection the sac was accidentally opened and 2 litres of straw coloured fluid was drained. The testis was small and atrophic. The sac was excised and orchidectomy done.

Fig. 1 : Showing two components of abdominoscrotal hydrocoele (ASH).

Discussion
Abdomino scrotal hydrocoele is the extreme form of a common inguinal pathology in young boys. Its origin is similar to that of scrotal hydrocoele, although the exact mechanism through which the peritoneal fluid is forced in to the retroperitoneum is still matter of debate. This anomaly consists of a large inguinoscrotal hydrocoele which communicates in an hour-glass fashion with a large “intra-abdominal” component. The latter lies deep to the inguinal ring, but superficial to the peritoneal cavity proper, which is displaced superiorly and medially. The process is entirely benign. However the long term consequences of pressure on pelvic and retroperitoneal structures is unclear, as is the fate of the stretched vas-deferens. Harmful effect of chronic hydrocoele on spermatogenesis2-4 and one case of mesothelioma developing in abdominal portion of chronic ASH have been reported.5

For all these reasons and cosmetic considerations, the treatment of choice is complete excision of the sac.

References

  1. Wlochynski T, Wasserman, et al. Abdominoscrotal hydrocele in childhood. J Paediatric Surgery 1993; 28 : 248-50.
  2. Dandapat MC, Pachi NC, Patra PA. Effect of hydrocele on testis and spermatogenesis. Br J Uro 1990; 77 : 1293-94.
  3. Poliloff L, Hadziselliarovis P, Herzog B, Jenni P. Does hydrocele affect ferlility? Fertil Steril 1990; 53 :
    700-3.
  4. Singh MP, Goel TC, Singh M, Chaudhary SR. Alterations in testicular functions in patients of scrotal hydrocele. Ind J Med Research 1989; 124-28.
  5. Velasco AL, Ophoven J, Priest JR, Brennam WS. Paratesticular malignant mesothelioma associated with abdominoscrotal hydrocele. J Pedia Surg 1988; 23 : 1065-67.

EXCESS CORONARY HEART DISEASE IN SOUTH ASIANS IN THE UNITED KINGDOM

Death rates from coronary heart disease in South Asians (immigrants from India, Pakistan, Bangladesh and Sri Lanka) have declined at a slower rate than in the indigenous population.

We still do not have an explanation for excess deaths from coronary heart disease in South Asians, but several plausible hypotheses have been generated.

Factors contributing to excess risk of coronary heart disease in South Asians

Migration
Disadvantaged socioeconomic status
“Proatherogenic” diet
Lack of exercise
High levels of homocysteine and LP(a) lipoprotein
Endothelial dysfunction
Enhanced plaque and systemic inflammation.
Lack of physical activity, lower consumption of fruits and vegetables, and a greater tendency to ill health in general is more prevalent in this subgroup than in Pakistanis or Indians.
More needs to be done. Firstly, South Asians need to be educated about the excess risk of coronary heart disease and its symptoms.

Velmurugan C Kuppuswamy, Sandeep Gupta, BMJ, 2005; 330 : 1223-24.

*Associate Professor and Unit Head; **Lecturer; ***Professor and HOD; ****Resident, Department of Surgery, MGM Medical College and Hospital, Kamothe, Navi Mumbai.